Doctors: Web ratings flawed

Web-savvy consumers use online rating services to review restaurants, rant about hairdressers, praise carpenters and even assess their college professors. So why shouldn't patients rate their doctors?

While more than 30 different online services now grade doctors, assessing a doctor's skills has turned out to be much more complicated and controversial than ranking hotels or restaurants. Critics say that most sites have too few reviews per doctor to offer statistically significant information, and the medical establishment has vocally questioned the concept.

But the trend gets another chance at growth this month, with one of the best-known restaurant guidebooks, Zagat, joining the field of medical reviews in Illinois in a limited way.

Traditionally, patients have found a physician by asking friends, family members or other doctors for a recommendation. Rating proponents say consumer reviews can identify competent practitioners, pressure physicians to improve and provide an overall assessment of the health care system.

"Most people can't figure out how to evaluate their doctor," said Dr. John Santa, director of the Consumer Reports Health Ratings Center, which recently rated surgical groups in the U.S. that perform heart bypass surgery, the company's first foray into physician ratings. "If you ask (focus groups) 'is it important that your doctor's advice is consistent with the evidence?' they will say, 'yes, but how would I know that?' "

Some companies, such as Consumer's Checkbook and Angie's List, which rate a broad range of consumer services online and in print publications, rely on subscribers to rate a doctor's care. Others, like Ratemds.com or Healthgrades.com, allow anyone to rate a doctor, and it's done anonymously.

But the sites are still not attracting enough ratings to give consumers useful information. Critics, including the American Medical Association, argue that manipulated, inaccurate or anonymous ratings could hurt a doctor's reputation.

"If there is a 'wisdom of the crowds,' on most sites, there is no crowd," said Dr. Jeffrey Segal, chief operating officer of Medical Justice, which works to protect doctors against online defamation and improve the health care system. "The average doctor sees between (1,000) and 3,000 patients a year, yet the typical site has zero to three posts. That doesn't even come close to a scintilla of statistical significance."

One way to garner a critical mass of participants may be to partner with a company already well-known for reputable reviews.

Blue Cross and Blue Shield of Illinois is teaming up with Zagat Survey, the famous restaurant and travel guide, for an online tool that allows members to rate their physicians in four categories: trust, communication, availability and office environment. Doctors' scores are only displayed on the site if they have reached 10 reviews.

Blue Cross and Blue Shield described the Zagat Health Survey, which launches at the end of November, as fulfilling "an unmet need for peer-to-peer interaction among health care consumers."

Still some doctors remain leery. Family practice physician Robert Boll, of Orland Park, a top doctor according to many sites, doesn't monitor his online presence or ask patients to rate him.

"I get rated by insurance companies and can't stand it," said Boll, who had 12 patient ratings and a 100 percent patient satisfaction rate, according to Consumer's Checkbook. "The stuff they come up with is rarely representative of what I do and how I do it."

But he does see a need for "objective, verifiable and uniform ratings." On vitals.com, which says it rates more than 700,000 doctors, Boll had just one rating. On ratemds.com, one of seven reviewers said "he cares more deeply about his patients than any other doctor I have ever met." But another complained that "his nurse has NEVER once picked up a phone."

Boll, who is affiliated with multiple insurance plans and Palos Community Hospital, said the hospital is looking for ways to assess his performance according to accepted benchmarks.

"It's a small part of what I earn, but the hospital says if I aggravate patients I make less money," he said. "They're clearly looking for ways to get a reasonable assessment of performance," he said.

Boll pointed out that he spends his day talking to people who are ill or in pain and not inclined to rate anyone or anything very highly.

"I get rated on everyone from the girls who open the window to the nurse who gives the shot," he said. "I understand there has to be something. I just don't have to agree to like it all."

Some sites make an effort to include doctors in the process. Angie's List, for example, encourages health care professionals to monitor the reports free of charge and respond to comments. If a doctor has an issue with a review, Angie's List will help investigative or put the patient and doctor in touch so they can resolve the issue. But doctors say they often don't have the time — or desire — to monitor more than 30 different sites.

Many physicians worry that the reviews will be negative and they won't have a chance to respond due to confidentiality issues. But Consumer's Checkbook only publishes doctors who have favorable reviews, and Angie's List founder Angela Hicks said that most people come to the site to find highly rated doctors.

Meanwhile, a study published earlier this year found that 90 percent of the reviews were positive.

"Most of the criticism focused on nontechnical aspects of care — not whether the diagnosis or surgery was correct but on the overall experience of the patient," said lead author Dr. Tara Lagu, an academic hospitalist at Baystate Medical Center in Springfield, Mass. "Was the room clean? The nurse nice? Was there a place to park? Very rarely did it talk about the clinical aspects of care," said Lagu, who coauthored a commentary on doctor-rating Web sites in the October issue of the Journal of the American Medical Association.

Therese Ruiz, 24, of Evanston, recently used online doctor ratings to find a new primary care physician. She already goes online to research restaurants and other consumer products, so she used the Web to whittle down the list of 384 potential candidates offered by her health insurance company.

She started with yelp.com, the restaurant review site, because "doctors often don't know they're being reviewed on that one." Then she went to healthgrades.com, bookofdoctors.com and doctors.webmd.com for a more in-depth look at their profiles and locations.

Ultimately, Ruiz, an administrative assistant at the University of Chicago, settled on three doctors because her next appointment will either be urgent or a year from now. She occasionally calls each one simply to test the friendliness of the receptionist. But her bottom line is access. "Whoever is available will be my pick," she said.